Pertussis: a concise historical review including diagnosis ... - sepeap
Pertussis: a concise historical review including diagnosis ... - sepeap
Pertussis: a concise historical review including diagnosis ... - sepeap
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80 Reviews in Medical Microbiology 2005, Vol 16 No 3<br />
German) kinkhoste is found in a source from 1464.<br />
Dodonaeus (1517–1585) in his Cruijde boeck [8] (book of<br />
herbs) from 1554 already describes cures for the kieckhoest!<br />
De Baillou called it quinta, referring to Hippocrates [1].<br />
Coqueluche, the present name in French for whooping<br />
cough, was then the common name for influenza [9].<br />
Holmes [10] reports that pertussis was called chyne-cough<br />
in England as early as 1519. Cherry and Heininger [11]<br />
say it was called the kink (in Scottish synonymous with fit<br />
or paroxysm) and kindhoest (a Teutonic word meaning<br />
child’s cough) in the Middle Ages. Nils Rosén von<br />
Rosenstein [6] calls it in his book about paediatric diseases<br />
from 1798 Keichhussten. InaJAMA editorial [12] names<br />
such as tosse canina (dog’s bark, Italy), Wolfshusten (howling<br />
of wolves) and Eselshusten (braying of donkeys) (both<br />
from Germany), and chincough (boisterous laughter, Old<br />
English) are given. In Chinese it is called ‘‘cough of<br />
100 days’’ [13]. In Dutch it is called kinkhoest, coming<br />
from old names as kinkhôste, kichhoest, keichhusten, asvan<br />
Esso describes [14]. In the Dictionary of the Dutch<br />
Language (Woordenboek der Nederlandsche Taal) [15] the<br />
same names are given, and others as kie(c)khoest, kijkhoest,<br />
kikhoest. Also it refers to Dodonaeus (1517–1585) who<br />
called the disease kich,orkinchoest in a latter edition of his<br />
‘‘Cruydt-Boeck’’ from 1608 [16].<br />
Since in these old days there were no possibilities to prove<br />
the <strong>diagnosis</strong> we will never know whether all these<br />
diseases then were the same as our whooping cough that,<br />
as we know today, is caused by B. pertussis, or that they<br />
were pertussis-like syndromes, caused by one or more<br />
other pathogens [17–23].<br />
stage usually lasts 1–6 weeks, but may persist for up to<br />
10 weeks.<br />
Young infants (under 6 months of age) may not have the<br />
strength to have a whoop, but they do have paroxysms of<br />
coughing. The cough though may be absent and disease<br />
may then manifest with spells of apnoea [24].<br />
Although pertussis may occur at any age, most cases of<br />
serious disease and the majority of fatalities are observed<br />
in early infancy. The most important complications in<br />
the USA are hospitalization (72.2% in children younger<br />
than 6 months, 3.9% for those over 20 years of age),<br />
bronchopneumonia (17.3 versus 3.4%), seizures (2.1<br />
versus 0.5%), acute encephalopathy (0.5 versus 0.1%), the<br />
latter frequently resulting in death or lifelong brain<br />
damage, and death (0.5 versus 0) [25]. Heininger reported<br />
in proven pertussis patients in Germany an overall<br />
complication rate of 5.8%, pneumonia (29%) being the<br />
most frequent complication. In infants less than 6 months<br />
of age, the rate of complications was 23.8% [26].<br />
At the end of the catarrhal phase, a leukocytosis with an<br />
absolute and relative lymphocytosis frequently begins,<br />
reaching its peak at the height of the paroxysmal stage. At<br />
this time, the total blood leukocyte levels may resemble<br />
those of leukaemia ( 100 000/ml), with 60–80%<br />
lymphocytes.<br />
The convalescent phase, the last stage, lasting 1–3 weeks,<br />
is characterized by a gradual, continuous decline of the<br />
cough before the patient returns to normal. However,<br />
paroxysms often recur with subsequent respiratory<br />
infections for many months after the onset of pertussis.<br />
Fever is generally minimal throughout the course of<br />
pertussis.<br />
Clinical manifestations<br />
Clinical manifestations of whooping cough may show<br />
substantial variation, depending on previous vaccination,<br />
earlier infection with B. pertussis, age or the clinical<br />
condition of the patient. The clinical course is divided<br />
into three stages. After an incubation period of 5–10 days,<br />
with an upper limit of 21 days, illness begins with the<br />
catarrhal phase. This phase lasts 1–2 weeks and is usually<br />
characterized by low-grade fever, rhinorrhoea, and progressive<br />
cough.<br />
In the subsequent paroxysmal phase, lasting several<br />
weeks, B. pertussis causes severe and spasmodic cough<br />
episodes with a characteristic whoop, often with cyanosis<br />
and vomiting. The patient usually appears normal<br />
between attacks. Paroxysmal attacks occur more frequently<br />
at night, with an average of 15 attacks per 24 h.<br />
During the first 1 or 2 weeks of this stage the attacks<br />
increase in frequency, then remain at the same level for 2–<br />
3 weeks, and then gradually decrease. The paroxysmal<br />
Microbiology<br />
The genus Bordetella contains species of related bacteria<br />
with similar morphology, size, and staining reactions. To<br />
date there are eight species known of Bordetella:<br />
B. pertussis [27], B. parapertussis [28,29], B. bronchiseptica<br />
[30], B. avium [31] (formerly designated Alcaligenes<br />
faecalis), B. hinzii [32,33] (formerly designated A. faecalis<br />
type II), B. holmesii [34], B. trematum [35] and B. petrii<br />
[36]. Bordetella pertussis, B. parapertussis and B. bronchiseptica<br />
are genomically closely related. The first four are<br />
respiratory pathogens. Bordetella pertussis is an obligate<br />
human pathogen. Bordetella pertussis was long considered<br />
the sole agent of whooping cough. A mild, pertussis-like<br />
disease in humans may be caused by B. parapertussis and<br />
occasionally by B. bronchiseptica. Bordetella parapertussis<br />
appears both in humans and animals. The natural habitat<br />
of B. bronchiseptica is the respiratory tract of smaller animals<br />
such as rabbits, cats, and dogs. Human infections with